title: Utilization of small pediatric donor kidneys: a decision analysis.
abstract: BACKGROUND
  Given the disparity between static supply and increasing demand for organs, the greatest challenge is broadening access to the benefits of kidney transplantation. Organs from small deceased pediatric donors are a potentially underused resource. These may be transplanted as en bloc kidney transplants (EBKTs) to one recipient or as single kidney transplants (SKTs) to two recipients, albeit with an increased risk of graft failure.
  
  
  METHODS
  A systematic literature search identified data on transplant outcomes for recipients of organs from small pediatric deceased donors. A decision analysis model was constructed to allow the outcome in life years (LY) to be predicted for patients with end-stage kidney disease on the transplant waiting list depending on whether they received EBKT or SKT.
  
  
  RESULTS
  At all recipient ages, the projected LY of both recipients of an SKT was greater than the projected LY of an EBKT recipient. The net estimated gain in LY associated with the SKT technique was greatest for recipients aged 20 to 39 years (14.3 years) and lowest for recipients aged 60 to 74 years (3.36 years). Only for recipients of organs from donors weighing less than 10 kg, there was an estimated net loss of LY associated with the SKT technique across all recipient age groups.
  
  
  CONCLUSIONS
  There is a greater gain in overall life expectancy using SKTs, because this technique yields two recipients per donor, which more than compensates for the increased risk of graft failure.
authors.affiliation: Department of Surgery, University of Sydney, Australia. jm_laurence@med.usyd.au
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Laurence
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
authors.forename: Vincent W T
authors.initials: VW
authors.lastname: Lam
authors.forename: Henry C C
authors.initials: HC
authors.lastname: Pleass
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.forename: Richard D M
authors.initials: RD
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D002675:Child, Preschool; D003661:Decision Support Techniques; D046148:Donor Selection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008017:Life Expectancy; D008875:Middle Aged; D009929:Organ Size; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult